Amelia Cook

Development of Smartphone Applications for Nutrition and Physical Activity Behavior Change

Background Young adults (aged 18 to 35) are a population group at high risk for weight gain, yet we know little about how to intervene in this group. Easy access to treatment and support with self-monitoring of their behaviors may be important. Smartphones are gaining in popularity with this population group and software applications (“apps”) used on these mobile devices are a novel technology that can be used to deliver brief health behavior change interventions directly to individuals en masse, with potentially favorable cost-utility. However, existing apps for modifying nutrition or physical activity behaviors may not always reflect best practice guidelines for weight management. Objective This paper describes the process of developing four apps aimed at modifying key lifestyle behaviors associated with weight gain during young adulthood, including physical activity, and consumption of take-out foods (fast food), fruit and vegetables, and sugar-sweetened drinks. Methods The development process involved: (1) deciding on the behavior change strategies, relevant guidelines, graphic design, and potential data collection; (2) selecting the platform (Web-based versus native); (3) creating the design, which required decisions about the user interface, architecture of the relational database, and programming code; and (4) testing the prototype versions with the target audience (young adults aged 18 to 35). Results The four apps took 18 months to develop, involving the fields of marketing, nutrition and dietetics, physical activity, and information technology. Ten subjects provided qualitative feedback about using the apps. The slow running speed of the apps (due to a reliance on an active Internet connection) was the primary issue identified by this group, as well as the requirement to log in to the apps. Conclusions Smartphone apps may be an innovative medium for delivering individual health behavior change intervention en masse, but researchers must give consideration to the target population, available technologies, existing commercial apps, and the possibility that their use will be irregular and short-lived.

Comparison of single questions and brief questionnaire with longer validated food frequency questionnaire to assess adequate fruit and vegetable intake

OBJECTIVE The aim of this study was to determine if a single question (SQ) for fruit and a SQ or five-item questionnaire for vegetable consumption (VFQ) could replace a longer food frequency questionnaire (FFQ) to screen for inadequate versus adequate intakes in populations. METHODS Participants (109) completed three test screeners: fruit SQ, vegetable SQ, and a five-item VFQ followed by the reference 74-item FFQ (version 2 of the Dietary Questionnaire for Epidemiological Studies [DQESv2]) including 13 fruit and 25 vegetable items. The five-item VFQ asked about intake of salad vegetables, cooked vegetables, white potatoes, legumes, and vegetable juice. The screeners were compared with the reference (DQESv2 FFQ) for sensitivity, specificity, and positive and negative predictive powers (PPV, NPV) to detect intakes of two or more servings of fruit and three or more servings of vegetables. Relative validity was examined using Bland-Altman statistics. RESULTS The fruit SQ showed a PPV of 56% and an NPV of 83%. The PPV for the vegetable SQ was 30% and the NPV was 89%. For the five-item VFQ, the PPV was 39% and the NPV was 85%. Bland-Altman plots and linear regression equations showed that although the screener showed good agreement for fruit (unstandardized b1 coefficient = 0.04) for vegetable intake the difference between methods increased at higher intake levels (unstandardized b1 coefficients = -0.3 for the SQ, b1 = -0.6 for five-item VFQ). CONCLUSION The fruit SQ and the five-item VFQ are suitable replacements for longer FFQs to detect inadequate intake and assess population mean but not individual intakes.

Prevalence of and intention to change dietary and physical activity health risk behaviours.

Poor nutrition and insufficient physical activity contribute to high rates of obesity. Prevalence, intention to change and co-occurrence of four health risk behaviours (inadequate fruit and vegetables, excessive dietary fat, excessive sugary beverages and inadequate physical activity in comparison to public health recommendations) were investigated in an Australian population of working adults. Participants (n=105) completed sociodemographic and stage of change questionnaires. A subsample (n=40) were assessed twice to estimate test-retest repeatability. In the full sample, 73% were female, mean age was 33.8 years and mean BMI was 23.8 kg/m(2). Eighty-seven percent of participants consumed inadequate fruit and vegetables, 43% had excessive dietary fat, 42% had excessive sugary beverages and 29% had inadequate physical activity. The proportions intending to change each behaviour were 57%, 25%, 18% and 24%, respectively. Two-thirds exhibited multiple risk behaviours and 38% intended to change multiple risk behaviours. Fruit and vegetables and dietary fat were the most commonly paired risk behaviours (39%) and the pair most intended to change (19%). Occurrence of multiple risk behaviours was associated with being male (OR 3.10, 95% CI 1.06-9.03) or overweight/obese (OR 2.66, 95% CI 1.02-6.93). Targeting two risk behaviours, particularly fruit and vegetables and dietary fat, may be appropriate when designing health promotion programs in working populations.

A systematic review of health promotion intervention studies in the police force: study characteristics, intervention design and impacts on health

To systematically review studies of health promotion intervention in the police force. Four databases were searched for articles reporting on prepost single and multigroup studies in police officers and trainees. Data were extracted and bias assessed to evaluate study characteristics, intervention design and the impact of interventions on health. Database searching identified 25 articles reporting on 21 studies relevant to the aims of this review. Few studies (n=3) were of long duration (≥6 months). Nine of 21 studies evaluated structured physical activity and/or diet programmes only, 5 studies used education and behaviour change support-only interventions, 5 combined structured programmes with education and behaviour change support, and 2 studies used computer prompts to minimise sedentary behaviour. A wide array of lifestyle behaviour and health outcomes was measured, with 11/13 multigroup and 8/8 single-group studies reporting beneficial impacts on outcomes. High risk of bias was evident across most studies. In those with the lowest risk of bias (n=2), a large effect on blood pressure and small effects on diet, sleep quality, stress and tobacco use, were reported. Health promotion interventions can impact beneficially on health of the police force, particularly blood pressure, diet, sleep, stress and tobacco use. Limited reporting made comparison of findings challenging. Combined structured programmes with education and behaviour change support and programmes including peer support resulted in the most impact on health-related outcomes.

Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review

Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is currently lacking. A systematic review of natural experiments of neighborhood built environment was conducted. The aims of this systematic review were to summarize study characteristics, study quality, and impact of changes in neighborhood built environment on physical activity and diet outcomes among residents. Natural experiments of neighborhood built environment change, exploring longitudinal impacts on physical activity and/or diet in residents, were included. From five electronic databases, 2084 references were identified. A narrative synthesis was conducted, considering results in relation to study quality. Nineteen papers, reporting on 15 different exposures met inclusion criteria. Four studies included a comparison group and 11 were pre-post/longitudinal studies without a comparison group. Studies reported on the impact of redeveloping or introducing cycle and/or walking trails (n = 5), rail stops/lines (n = 4), supermarkets and farmers’ markets (n = 4) and park and green space (n = 2). Eight/15 studies reported at least one beneficial change in physical activity, diet or another associated health outcome. Due to limitations in study design and reporting, as well as the wide array of outcome measures reported, drawing conclusions to inform policy was challenging. Future research should consider a consistent approach to measure the same outcomes (e.g., using measurement methods that collect comparable physical activity and diet outcome data), to allow for pooled analyses. Additionally, including comparison groups wherever possible and ensuring high quality reporting is essential.

The relationship between process use and stage of change for sugary drinks

BACKGROUND Decreasing sugar-sweetened beverage consumption may reduce obesity and obesity-related diseases. To better understand what processes could facilitate a reduction in sugary beverage intake, we examined the relationship between stage-of-change and use of 10 processes of change. Secondarily, reliability of the measure was assessed. METHODS A cross-sectional study was conducted, using a newly developed stage-of-change and process of change questionnaire. Participants (n = 105; male, n = 28) were aged between 18 and 60 years. A one-way analysis of variance, with Tukeys and Benjamini-Hochberg post hoc tests, was used to compare process use by stages. Paired t-tests were used to compare total cognitive and total behavioural process use within each stage. Cronbachs α coefficient and mean inter-item correlation was used to assess internal consistency. Reliability of repeated items was examined using kappa. RESULTS Cognitive and behavioural processes were used more in the contemplation/preparation and maintenance stages than in precontemplation (all P < 0.05). Compared to precontemplation, process use was significantly higher in contemplation/preparation for five individual processes, action for four processes and maintenance for five processes. The use of dramatic relief and self liberation was lower in maintenance than contemplation/preparation. Across the stages, the use of eight of the 10 processes differed. The use of consciousness raising, self re-evaluation and self liberation differed between stages more frequently than other processes. CONCLUSIONS The use of many processes differed by stage and could be incorporated into programmes aiming to assist adults in reducing their consumption of sugary drinks.

Building an army of wombat warriors: developing and sustaining a citizen science project

Citizen science websites and mobile applications are credited for their ability to engage members of the public in science and enhance scientific literacy, while operating as a cost-effective, geographically vast data-collection tool. Recruiting participants, tailoring online platforms to users’ needs and harnessing community values are key to creating a successful, sustainable citizen science project. However, few studies have conducted a detailed examination of the recruitment experience when trying to build an engaged and active citizen science audience to assess wildlife diseases in Australia. The present study aimed to determine the most effective methods to recruit and continue to engage citizens to use the tool called WomSAT (Wombat Survey and Analysis Tools). Various marketing techniques were employed to recruit participants. A survey was also disseminated to gain feedback on WomSAT and understand the driving factors behind participation. Participation in the WomSAT project was driven by a collective desire to help and learn about wombats. Preliminary distribution data collected by citizens suggest that WomSAT contains the necessary elements to enable it to be an important tool for monitoring wombats and the distribution of disease. Continuation of the WomSAT project will support scientific research while fostering conservation messages amongst the Australian community.

Smart Nutrition Monitoring System Using Heterogeneous Internet of Things Platform

Poor nutrition impairs the health and wellbeing of the population and increases the risk of chronic diseases such as obesity and type 2 diabetes. Chronic diseases that require dietary management can be better managed if food and nutrition intake is monitored. Existing methods for measurement are inaccurate and not scalable as they are based on a person’s ability to recall and self-report. In this paper, we propose a smart nutrition monitoring system based on Internet of Things (IoT) technologies to collect reliable nutrition intake data from heterogeneous sensors. The proposed method is non-invasive and consists of a combination of data sources from heterogeneous devices to increase accuracy. The system architecture is based on emerging Fog Computing concepts where data collection points are able to do the preprocessing and lightweight analytics before sending data to the Cloud. The system prototype is developed using various sensors including cameras to generate 3D images for food volume estimation.